北加日米会 2015 年度会費納入書
(Hokka Nichibei Kai 2015 Membership Dues)
Name ( Mr. / Ms. )
(Optional)
Name in Japanese (日本語の名前)
Address
Telephone (Home)
(Work)
E-mail
Fax
o
E-mail is capable of Japanese language (日本語メール可)
o
Are you Japanese Citizen? (In case of emergency, the Japanese consulate will contact you)
Category (Please check one):
o Individual Member ($40)
o Family Member ($70 /couple)
(Name of family member _________________________________________________)
o Group Member ($40 /person~ ) ____________________________________________
(List a group name and address)
____________________________________________________________________
o Supporting Member ($175)
* Please make a check payable to Hokka Nichibei Kai and mail to:
Hokka Nichibei Kai 1759 Sutter Street, San Francisco, CA 94115
Questionnaire (Optional):
Are you interested in or willing to help us in the following program areas?
（下記のような北加日米会主催の行事、活動に興味のある方、又はお手伝い出来る方はチェックして下さい。）
o
o o
o
Tea Ceremony（北加日米会ティーソサエティー、お茶会）o
Japanese Speech Contests (日本語弁論大会) Building/Garden Maintenance (建物･庭管理)
Cultural Program（文化プログラム）
History Project（日系史編纂）
o Planning of Special Events（行事企画）
o Accounting and Treasurer’s work（会計）
o Others ______________________________
Thank you for your support.

理事長 鈴木 絹英 - 宇部市社会福祉協議会

Do Justice! - 北海道警察ホームページ